Skip to main content

Advertisement

SpringerLink
Log in

Intellectual Disability and Homelessness: a Synthesis of the Literature and Discussion of How Supportive Housing Can Support Wellness for People with Intellectual Disability

  • Intellectual Disability (Y Lunsky, Section Editor)
  • Published:
Current Developmental Disorders Reports Aims and scope Submit manuscript

Abstract

Recent Findings

Although rates of intellectual disabilities (ID) may be elevated in homeless populations, there is little research on homeless adults with ID whose cognitive and adaptive functioning deficits may affect how they respond to usual supports.

Purpose of Review

This literature synthesis describes the prevalence of ID among homeless adults, the needs of adults experiencing homelessness who have ID, and discusses implications for providing Housing First to people with ID. Housing First is an evidence-based intervention commonly delivered to homeless populations.

Summary

People with ID are vastly overrepresented in homeless populations, with prevalence estimates ranging from 12–39% across countries, although none are population-based. Limited evidence also suggests that homeless people with ID may have more enduring needs than other homeless people, suggesting a need for longer term supports. More research will be instrumental in determining if Housing First models are appropriate for this population and if adaptations are necessary to account for their unique needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Lougheed D, Farrell S. The challenge of a “triple diagnosis”: identifying and serving homeless Canadian adults with a dual diagnosis. J of Policy and Practice in Intellect Disabilities. 2013;10:230–5. https://doi.org/10.1111/jppi.12041.

    Article  Google Scholar 

  2. Durbin A, Lunsky Y, Wang R, Nisenbaum R, Hwang S, O’Campo P, Stergiopoulos V. Borderline intellectual functioning and duration of homelessness among adults with mental illness. Health Policy Submitted January 2018.

  3. Housing is the Best Medicine Supportive Housing and the Social Determinants of Health. CSH. The source for housing solutions. July 2014. http://www.csh.org/resources/housing-is-the-best-medicine-supportive-housing-and-the-social-determinants-of-health/. Accessed May 3, 2018.

  4. American Association of Intellectual and Developmental Disabilities: Definition of intellectual disability. http://aaidd.org/intellectual-disability/definition#.WvQxXNPwYu8 (2018). Accessed 13 Apr 2018.

  5. Lunsky Y, Klein-Geltink JE, Yates EA, editors. Atlas on the primary care of adults with developmental disabilities in Ontario. https://www.ices.on.ca/Publications/Atlases-and-Reports/2013/Atlas-on-Developmental-Disabilities. Accessed 12 Apr 2018.

  6. McKenzie K, Milton M, Smith G, Ouellette-Kuntz H. Systematic review of the prevalence and incidence of intellectual disabilities: current trends and issues. Curr Developmental Disorders Reports. 2016;3:104–15. https://doi.org/10.1007/s40474-016-0085-7.

    Article  Google Scholar 

  7. Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil. 2011;32:419–36. https://doi.org/10.1016/j.ridd.2010.12.018.

    Article  PubMed  Google Scholar 

  8. Bremner AJ, Duke PJ, Nelson HE, Pantelis C, Barnes TR. Cognitive function and duration of rooflessness in entrants to a hostel for homeless men. Br J Psychiatry. 1996;169:434–9. https://doi.org/10.1192/bjp.169.4.434.

    Article  CAS  PubMed  Google Scholar 

  9. Oakes PM, Davies RC. Intellectual disability in homeless adults: a prevalence study. J Intellect Disabil. 2008;12:325–34. https://doi.org/10.1177/1744629508100496.

    Article  PubMed  Google Scholar 

  10. Solliday-McRoy C, Campbell TC, Melchert TP, Young TJ, Cisler RA. Neuropsychological functioning of homeless men. J Nerv Ment Dis. 2004;192:471–8. https://doi.org/10.1097/01.nmd.0000131962.30547.26.

    Article  PubMed  Google Scholar 

  11. Van Straaten B, Schrijvers CT, Van der Laan J, Boersma SN, Rodenburg G, Wolf JR, et al. Intellectual disability among Dutch homeless people: prevalence and related psychosocial problems. PLoS One. 2014;9:e86112. https://doi.org/10.1371/journal.pone.0086112.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. • Van Straaten B, Rodenburg G, Van der Laan J, Boersma SN, Wolf JR, Van de Mheen D. Self-reported care needs of Dutch homeless people with and without a suspected intellectual disability: a 1.5-year follow-up study. Health & Soc Care in the Community. 2017;25:123–36. https://doi.org/10.1111/hsc.12287. This Netherlands-based article shows the prevalence of ID among a homeless sample. It also compares individuals who are homeless with an ID to individuals who are homeless but do not have an ID in terms of met, unmet and no need across broad domains.

    Article  Google Scholar 

  13. Nishio A, Yamamoto M, Ueki H, Watanabe T, Matsuura K, Tamura O, et al. Prevalence of mental illness, intellectual disability, and developmental disability among homeless people in Nagoya, Japan: a case series study. Psychiatry Clin Neurosci. 2015;69:534–42. https://doi.org/10.1111/pcn.12265.

    PubMed  Google Scholar 

  14. Nishio A, Yamamoto M, Horita R, Sado T, Ueki H, Watanabe T, et al. Prevalence of mental illness, cognitive disability, and their overlap among the homeless in Nagoya, Japan. PLoS One. 2015;10:e0138052. https://doi.org/10.1371/journal.pone.0138052.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Nishio A, Horita R, Sado T, Mizutani S, Watanabe T, Uehara R, et al. Causes of homelessness prevalence: relationship between homelessness and disability. Psychiatry Clin Neurosci. 2017;71:180–8. https://doi.org/10.1111/pcn.12469.

    Article  PubMed  Google Scholar 

  16. Okuda K. For support and understand the people who is homeless states. Homeless and Society. 2010;13:90–5.

    Google Scholar 

  17. Mathias JL, Bowden SC, Barrett-Woodbridge M. Accuracy of the Wechsler test of adult reading (WTAR) and National Adult Reading Test (NART) when estimating IQ in a healthy Australian sample. Aust Psychol. 2007;42:149–56. https://doi.org/10.1080/00050060600827599.

    Article  Google Scholar 

  18. • Durbin A, Lunsky Y, Wang R, Nisenbaum R, Hwang S, O’Campo P, et al. The effect of Housing First on housing stability for people with low intellectual functioning. Can J Psychiatr. 2018:27. Submitted Feb 5 2018. This article assessed how individuals with borderline or lower intellectual functioning fared in Housing First models. It showed no differences in housing stability for individuals with borderline or lower intellectual compared to people with higher than borderline intellectual functioning. However, more outcomes beyond housing stability should be examined to determine if any group differences emerged. Also, future work should distinguish between people with intellectual disabilities and borderline intellectual functioning.

  19. Mercier C, Picard S. Intellectual disability and homelessness. J Intellect Disabil Res. 2011;55:441–9. https://doi.org/10.1111/j.1365-2788.2010.01366.x.

    Article  CAS  PubMed  Google Scholar 

  20. Fournier L. Enquête auprès de la clientèle des ressources pour personnes itinérantes des régions de Montréal-Centre et de Québec, 1998–1999. In: Collection la santé et le bien-être. Institut de la Statistique du Québec. 2001. http://www.stat.gouv.qc.ca/statistiques/sante/etat-sante/sante-globale/enquete-itinerants-1.pdf. Accessed 10 Mar 2018.

  21. Woodhall-Melnik JR, Dunn JR. A systematic review of outcomes associated with participation in housing first programs. Hous Stud. 2016;31:287–304. https://doi.org/10.1080/02673037.2015.1080816.

    Article  Google Scholar 

  22. Iaquinta MS. A systematic review of transition from homelessness to finding a home. J Community Health Nurs. 2016;33:20–41. https://doi.org/10.1080/07370016.2016.1120593.

    Article  PubMed  Google Scholar 

  23. Kennedy J, Arku G, Cleave E. The experiences of front-line service providers of housing first programme delivery in three communities in Ontario, Canada. International J of Hous Policy. 2017;17:396–416. https://doi.org/10.1080/14616718.2016.1248528.

    Article  Google Scholar 

  24. Hwang SW, Burns T. Health interventions for people who are homeless. Lancet. 2014;384:1541–7. https://doi.org/10.1016/S0140-6736(14)61133-8.

    Article  PubMed  Google Scholar 

  25. Tsemberis S, Eisenberg RF. Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatr Serv. 2000;51:487–93. https://doi.org/10.1176/appi.ps.51.4.487.

    Article  CAS  PubMed  Google Scholar 

  26. Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing Housing First with Treatment First programs. Community Ment Health J. 2011;47:227–32. https://doi.org/10.1007/s10597-009-9283-7.

    Article  PubMed  Google Scholar 

  27. Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA. 2015;313:905–15. https://doi.org/10.1001/jama.2015.1163.

    Article  CAS  PubMed  Google Scholar 

  28. • Ombudsman’s report: nowhere to turn. Investigation launched November 29, 2012. Report released August 24, 2016. https://www.ombudsman.on.ca/Files/sitemedia/Documents/NTT-Final-EN-w-cover.pdf. The Ontario Ombudsman report Called “Nowhere to Turn ,” is based on a four-year investigation into the care and treatment of adults with developmental disabilities. It reported that this population commonly experienced homelessness, incarceration, abuse and neglect. Appropriate housing is one the key issues discussed in this report.

  29. Burge P. Assertive community treatment teams and adults with intellectual disabilities. Journal on Developmental Disabilities. 2009;15:96–102.

    Google Scholar 

  30. Bigby C, Ozanne E, Gordon M. Facilitating transition: elements of successful case management practice for parents of older adults with Intellectual disability. J Gerontol Soc Work. 2002;37:25–43. https://doi.org/10.1300/J083v37n03_04.

    Article  Google Scholar 

  31. Hassiotis A, Ukoumunne OC, Byford S, Tyrer P, Harvey K, Piachaud J, et al. Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management Report from the UK700 trial. Br J Psychiatry. 2001;178:166–71.

    Article  CAS  PubMed  Google Scholar 

  32. Martin G, Costello H, Leese M, Slade M, Bouras N, Higgins S, et al. An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical and service issues. J Intellect Disabil Res. 2005;49:516–24. https://doi.org/10.1111/j.1365-2788.2005.00709.x.

    Article  CAS  PubMed  Google Scholar 

  33. Oliver PC, Piachaud J, Tyrer P, Regan A, Dack M, Alexander R, et al. Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study. J Intellect Disabil Res. 2005;49:507–15. https://doi.org/10.1111/j.1365-2788.2005.00706.x.

    Article  CAS  PubMed  Google Scholar 

  34. Burra TA, Stergiopoulos V, Rourke SB. A systematic review of cognitive deficits in homeless adults: Implications for service delivery. Can J Psychiatr. 2009;54(2):123–33.

    Article  Google Scholar 

  35. Roy S, Nuamah O, Hewitt T, Budin R, & Svoboda, T. Intellectual Disabilities in the Toronto Shelter System: Triage, Screening and Developmental Services Ontario (DSO) Eligibility..

  36. Somers JM, Moniruzzaman A, Patterson M, Currie L, Rezansoff SN, Palepu A, et al. A randomized trial examining Housing First in congregate and scattered site formats. PLoS One. 2017;12:e0168745. https://doi.org/10.1371/journal.pone.0168745.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Collins SE, Malone D, Clifasefi SL. Housing retention in single-site Housing First for chronically homeless individuals with severe alcohol problems. Am J Public Health. 2013;103:S269–74. https://doi.org/10.2105/AJPH.2013.301312.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McGillicuddy NB. A review of substance use research among those with mental retardation. Developmental Disabilities Research. 2006;12:41–7. https://doi.org/10.1002/mrdd.20092.

    Google Scholar 

  39. McLaughlin DF, Taggart L, Quinn B, Milligan V. The experiences of professionals who care for people with intellectual disability who have substance related problems. J Substance Use. 2007;12:133–43. https://doi.org/10.1080/14659890701237041.

    Article  Google Scholar 

  40. van Duijvenbode N, VanDerNagel JE, Didden R, Engels RC, Buitelaar JK, Kiewik M, et al. Substance use disorders in individuals with mild to borderline intellectual disability: current status and future directions. Res Dev Disabil. 2015;38:319–28. https://doi.org/10.1016/j.ridd.2014.12.029.

    Article  PubMed  Google Scholar 

  41. Lin E, Balogh R, McGarry C, Selick A, Dobranowski K, Wilton AS, et al. Substance-related and addictive disorders among adults with intellectual and developmental disabilities (IDD): an Ontario population cohort study. BMJ Open. 2016;6:e011638. https://doi.org/10.1136/bmjopen-2016-011638.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lunsky Y, Durbin A, Brown HK, Bansal S, Heifetz M, Antonio T. Health profiles and associated service use among adults with HIV and intellectual and developmental disabilities. AIDS. 2017;31:697–705. https://doi.org/10.1097/QAD.0000000000001361.

    Article  PubMed  Google Scholar 

  43. Durbin A, Brown HK, Bansal S, Antoniou T, Jung JKH, Lunsky Y. How HIV affects health and service use for adults with intellectual and developmental disabilities. J Intellect Disabil Res. 2017;61:682–96. https://doi.org/10.1111/jir.12381.

    Article  CAS  PubMed  Google Scholar 

  44. Sullivan B, Diepstra H, Heng J, Bradley E, Casson I, Hennen B, et al. Primary care of adults with intellectual and developmental disabilities. Can Fam Physician. 2018;64:254–79.

    PubMed  PubMed Central  Google Scholar 

  45. Lennox NG, Diggens J, Ugoni A. Health care for people with an intellectual disability: general practitioners’ attitudes, and provision of care. J Intellect Develop Disabil. 2009;25:127–33. https://doi.org/10.1080/13269780050033544.

    Article  Google Scholar 

  46. Lennox NG, Diggens JN, Ugoni AM. The general practice care of people with intellectual disability: barriers and solutions. J Intellect Disabil Res. 2007;41:380–90. https://doi.org/10.1111/j.1365-2788.1997.tb00725.x.

    Article  Google Scholar 

  47. Martin G. Support for people with learning disabilities: the role of primary care. Prim Care Community Psychiatry. 2005;10:133–42.

    Article  Google Scholar 

  48. Ouellette-Kuntz H. Understanding health disparities and inequities faced by individuals with intellectual disabilities. J Appl Res Intellect Disabil. 2005;18:113–21. https://doi.org/10.1111/j.1468-3148.2005.00240.x.

    Article  Google Scholar 

  49. Scheepers M, Kerr M, O’Hara D, Bainbridge D, Cooper S, Davis R, et al. Reducing health disparity in people with intellectual disabilities: a report from Health Issues Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities. J Policy Pract Intell Disabil. 2005;2:249–55. https://doi.org/10.1111/j.1741-1130.2005.00037.x.

    Article  Google Scholar 

  50. Brady N, Halm L. Speech, language, and communication assessments and interventions. In: Wehmeyer ML, Brown I, Percy M, Shogren KA, Fung WLA, editors. Comprehensive guide to intellectual and developmental disabilities. Brooks: Baltimore; 2017. p. 447–60.

    Google Scholar 

  51. Brown I & Percy M. (Editors.). Developmental disabilities in Ontario (3rd Edition) Ontario Association on Developmental Disabilities. Toronto. Front Page Publishing. 2011.

  52. Condillac R. Behavioral intervention. In: Wehmeyer ML, Brown I, Percy M, Shogren KA, Fung WLA, editors. Comprehensive guide to intellectual and developmental disabilities. Baltimore: Brooks; 2017. p. 401–12.

    Google Scholar 

Download references

Acknowledgements

The authors would like to thank Tomislav Svoboda, Frances McNeil, Radek Budin, and Terri Hewitt for their part in discussions that were reflected in this work.

Author information

Authors and Affiliations

  1. Centre for Urban Health Solutions, St Michael’s Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada

    Anna Durbin & Vicky Stergiopoulos

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Anna Durbin & Vicky Stergiopoulos

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Anna Durbin

  4. Surrey Place, Toronto, ON, Canada

    Barry Isaacs

  5. Queen’s University School of Medicine, Kingston, ON, Canada

    Dane Mauer-Vakil

  6. Inner City Family Health Team, Toronto, ON, Canada

    Jo Connelly

  7. St. Stephen’s Community House, Toronto, ON, Canada

    Lorie Steer

  8. Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada

    Sylvain Roy & Vicky Stergiopoulos

  9. York University, Toronto, ON, Canada

    Sylvain Roy

Authors
  1. Anna Durbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barry Isaacs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dane Mauer-Vakil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jo Connelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lorie Steer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sylvain Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vicky Stergiopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Durbin.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Intellectual Disability

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Durbin, A., Isaacs, B., Mauer-Vakil, D. et al. Intellectual Disability and Homelessness: a Synthesis of the Literature and Discussion of How Supportive Housing Can Support Wellness for People with Intellectual Disability. Curr Dev Disord Rep 5, 125–131 (2018). https://doi.org/10.1007/s40474-018-0141-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40474-018-0141-6

Keywords

Search

Navigation